Type 1 Diabetes Self-Management From Emerging Adulthood Through Older Adulthood.

Abstract

The purpose of this study of adults with type 1 diabetes was to analyze patterns of diabetes self-management behaviors and predictors of glycemic control across the adult life span. This study was a secondary cross-sectional analysis of data of 7,153 adults enrolled in the T1D Exchange Clinic Registry who were divided into four developmental stages (emerging, young, middle-aged, and older adults). Data were collected by questionnaire and medical record review at enrollment. Statistical analyses compared sociodemographic, clinical, and diabetes-related factors across groups. Logistic regressions were conducted for each group to identify factors associated with hemoglobin A_1c ≥7%. The sample was divided according to adult developmental stage: emerging adults, age 18 to <25 years (<i>n</i> = 2,478 [35%]); young adults, age 25 to <45 years (<i>n</i> = 2,274 [32%]); middle-aged adults, age 45 to <65 years (<i>n</i> = 1,868 [26%]); and older adults, age ≥65 years (<i>n</i> = 533 [7%]). Emerging adults had the highest mean hemoglobin A_1c level (8.4 ± 1.7% [68 mmol/mol]), whereas older adults had the lowest level (7.3 ± 0.97% [56 mmol/mol]; <i>P</i> < 0.0001). Emerging adults were less likely to use an insulin pump (56%) or a continuous glucose monitor (7%) but were more likely to miss at least one insulin dose per day (3%) and to have had an episode of diabetic ketoacidosis in the past year (7%) (all <i>P</i> < 0.0001). Different factors were associated with hemoglobin A_1c ≥7% in each age-group, but two factors were noted across several groups: the frequency of blood glucose checks and missed insulin doses. When discussing diabetes self-management, providers may consider a patient's developmental stage, with its competing demands (such as work and family), psychosocial adjustments, and the potential burden of comorbidities.